National Nurses United

partners, among which it counts Big Pharma companies such as Merck and Pfizer, and global healthcare conglomerates such as Nestlé Health Sciences, McKesson, and Johnson and Johnson. Chief among these efforts is the push for a nationwide licensure compact for registered nurses. Under compact licensure, state legisla- tures authorize state boards of nursing to enter into an agreement with NCSBN to allow RNs licensed to practice in their home states to also practice in any other of the compact states without first securing a license directly from that state. Sometimes this arrangement is also called a "multistate license." The NCSBN and compact licensure back- ers, which include corporate healthcare management and industry- backed groups such as the American Organization of Nurse Executives and the American Telemedicine Association, argue that this type of reciprocity agreement among compact states helps nurses by making your nursing license more portable. Get licensed in one state and you can practice in dozens more! NCSBN states very clearly on its websites that a major organizational goal is to remove barriers to expansion of telehealth, that it seeks to remove the "burdensome expense for organi- zations that employ nurses" (such as traveler and union-busting staffing agencies), and that it believes the current model of state-by- state nurse licensure is outdated and should be abandoned. While the licensure compact does indeed make it easier for indi- vidual RNs to practice in more states, the system also carries heavy and often unexamined consequences, too, that do not bode well for the overall profession of nursing. National Nurses United and its Joint Nursing Practice Commission officially oppose the licensure compact because they believe that the system irrevocably under- mines high standards in nurse licensure, consequently lowering standards for patient safety. Beyond that, it ultimately transfers con- trol of who can be and what it means to be a registered nurses from state boards of nursing, public bodies accountable to nurses and patients, to the hands of healthcare corporations whose number one goal is to maximize profit, not protect and heal patients, and cer- tainly not to advance the profession of nursing. "I don't trust the NCSBN," said Lisa Oliver, an intensive care unit RN in Maine who serves on NNU's Joint Nursing Practice Commis- sion. "There's an agenda out there and it's all predicated on money and power. I don't trust that they will have the patients and nurses' best interests at stake. They have their own interests to make money and gain power." T he idea of compact licensure is not new and has already been implemented in 31 states—Louisiana just enacted legislation on May 31 to establish "enhanced nurse licensure compact" (or eNLC) in the state. If you take a map of our country's so-called "right-to-work" states (these are states where workers, even if a majority have voted to unionize and even if the union represents everyone, are not required to be members and pay union dues) and match it up against the map of compact licensure states, the overlap is striking. This is no coinci- dence. States that have weak protections for workers tend to have weaker regulatory standards across the board. States with strong nursing unions have also been able to stave off this type of legislation. Currently, states such as California, Washington, Oregon, Nevada, Minnesota, Illinois, Michigan, Pennsylvania, New York, and Massa- chusetts, among others, are not part of the nurse license compact. When the NCSBN first rolled out the nurse licensure compact in 1999, largely to set the stage for telenursing, a number of states jumped on board quickly. But then further state adoption stalled by 2010. Some state boards of nursing had concerns about lack of unifor- mity in licensing requirements, the lack of background check require- ments in some of the compact states, and loss of revenue to boards of nursing, among other issues. In response, the NCSBN proposed a 2.0 version of the NLC, called the "enhanced Nurse Licensure Compact." This newer iteration was even more encompassing and vested the group with even greater power over nurse licensing. A new Interstate Commission was created with one administrator per state (by default the head of the state's board of nursing) and one vote per administrator. This commission has the power to make new rules with a majority vote that had the force of law in the compact states. The eNLC also created a new licensure information system between states and uniform licensing requirements. But there are still many murky aspects to quite a number of the eNLC's provisions and how they would be implemented. It went into effect Jan. 19, 2018. Y es, at first glance, the idea of getting a license that allows you to practice in multiple states without formally getting licensed in each state sounds great. There's less paperwork, you may save money on fees. The NCSBN argues that compact licensure helps RNs in military families (who often get moved around a lot) and helps increase healthcare access for rural patients by allowing more nurses to practice nursing through telehealth initiatives. They like to compare compact licensure to our system for driver's licenses; if you get a driver's license in one state, the license permits you to drive in other states. But take a closer look, and compact licensure looks a lot less shiny. For starters, different states have different nursing practice laws and different requirements for obtaining and maintaining licensure. Some states, such as California, require you to have graduated from a nursing school that mandates you complete a certain number of clinical hours. For this reason, California will not license nurse grads from an online school called Excelsior College, based out in Albany, New York—even if that person passed the NCLEX. Some states don't require background checks and fingerprinting of nurse license applicants. Some states don't require you to complete continuing education hours in order to keep up your license. Arizona, Colorado, Georgia, Idaho, Maine, Mississippi, Missouri, Montana, Oklahoma, South Dakota, Virginia, and Wisconsin are compact states that fall under this category. By joining in the nurse licensure compact, state boards of nurs- ing are essentially abandoning their own, perhaps higher, standards and giving up (to the Interstate Commission) their power to control how nursing is practiced in their state and their duty to protect patients in their state. "Being from California, we have some of the toughest regulations for nurses in the country, and we don't want that to be watered down," said Joan Silva, an RN from San Luis Obispo and a member of NNU's Joint Nursing Practice Commission. "The [board of regis- tered nursing] is there to protect patients from us, the nurses. And that's the way it should be." Another consideration that bodes poorly for maintaining robust boards of nursing is that compact licensure potentially deprives state boards of revenue when license applicants no longer need to M A R C H | A P R I L 2 0 1 8 W W W . N A T I O N A L N U R S E S U N I T E D . O R G N A T I O N A L N U R S E 15

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